普鲁泊福复合不同剂量瑞芬太尼应用于非肌松剂气管插管的观察

Objective To observe the impacts on the patients with cardiovascular responses when applying propofol combined with different dose of remifentanil in tracheal intubation without the use of muscle relaxants for anesthesia induction. Methods Sixty patients undergoing selective general anesthesia operation of ASA Ⅰ -Ⅱ non-heart and brain surgery were divided into three groups by random digits table, and 20 cases for each group. Target-controlled infusion of remifentanil with respective plasma concentration of 2 ng/ml (group Ⅰ ), 3 ng/ml (group Ⅱ ) and 4 ng/ml (group Ⅲ). Target-controlled infusion of propofol after infusion of remifentanil for 5 min (3 μg/ml of plasma target concentration). The mean arterial pressure (MAP),heart rate (HR), intubation conditions and success rate of patients in different groups before induction(T1), at the beginning moment of propofol(T2),at the immediate moment before tracheal intubation (T3) and at the time of 1 min after tracheal intubation (T4). Results The grade of tracheal intubation was (10.5 ±2.9), (7.6 ±2.3), (5.8 ± 1.2) scores and the success rate of the first intubation was 50%( 10/20), 80%(16/20), 100%(20/20) in group Ⅰ ,Ⅱ and Ⅲ , there were significant differences among three groups (P＜ 0.05),group Ⅲ was superior to group Ⅰ and Ⅱ (P＜0.05). Comparing T2 and Tj,HR in group Ⅱ and Ⅲ slowed down significantly ( P ＜ 0.05), and in group Ⅲ slowed down more significantly (P＜0.05). Comparing T4 and T3,HR in group Ⅰ and Ⅱ quickened significantly, and group Ⅰ was higher than group Ⅱ and Ⅲ (P＜ 0.05). Comparing T3 and T2,MAP decreased significantly among three groups,comparing T4 and T3, MAP increased significantly in group Ⅰ which was higher than that in group Ⅱ and Ⅲ (P ＜ 0.05). Conclusions Without the use of muscle relaxants, propofol combined with remifentanil for 3-4 ng/ml can better restrain the tracheal intubation stress responses and won't cause significant cycle inhibition. They benefit to maintain the smooth intubation process of anesthesia induction.     

雷米芬太尼对全麻患者气管插管期平均动脉压、心率和QTc间期延长的影响

Objective To evaluate the effect of remifentanil on mean arterial pressure (MAP), heart rate (HR) and QTc interval during tracheal intubation of general anesthesia patients. Methods Seventy-five ASA Ⅰ -Ⅱ grade patients were selected and allocated to receive either saline (group C), remifentanil 0.50 μg/kg (group R1) or remifentanil 0.75 μg/kg(group R2) by random digits table with 25 cases in each, they were administrated as a bolus intravenous, followed by a continuous infusion at 0.10 μg/ (kg·min), 1 min before laryngoscopy. All patients received fentanyl 3 μg/kg,propofol 1.0 - 1.5 mg/kg and vecuronium 0.1 mg/kg. The ECG.MAP and HR were recorded prior to induction of anesthesia (T0), 2 min following the start of drug intravenous of fentanyl and propofol with vecuronium (T1), 1 min following remifentanil or saline (T2), before laryngoscopy(T3), 30 s (T4), 2 min (T5) and 4 min (T6) after intubation. Results The QTc interval was significantly prolonged immediately following intubation in group C and group R1, but it remained stable in group R2, compared with the QTc interval just before laryngoscopy. In group R2, QTc interval was significantly shorter at T4-T6 compared to group C(P＜ 0.05 or ＜ 0.01). QTc interval significantly increased from baseline at T4 in group R1 and T4-T6 in group C (P＜ 0.05 or ＜ 0.01). The number of patients with QTc interval ＞ 440 ms were significantly greater immediately following tracheal intubation in group C than that in group R2 [44% (11/25) vs. 12% (3/25)] (P ＜ 0.05). Conclusions QTc interval increases following tracheal intubation during induction of anesthesia using fentanyl and propofol. Intravenous of remifentanil attenuates the QTc interval prolongation associated with tracheal intubation. In addition, remifentanil decreases the hemodynamic responses to tracheal intubation.     

雷米芬太尼对全麻患者气管插管期平均动脉压、心率和QTc间期延长的影响

目的 观察和评价雷米芬太尼对全麻患者气管插管期平均动脉压(MAP)、心率和QTc间期的影响.方法 选取择期全麻手术患者75例,ASA分级Ⅰ～Ⅱ级,按随机数字表法分为三组:对照组(C组)、雷米芬太尼Ⅰ组(R1组)和雷米芬太尼Ⅱ组(R2组),每组25例.麻醉诱导:静脉注射芬太尼3μg/kg、普鲁泊福1.0～1.5 mg/kg和维库溴铵0.1 mg/kg后2 min,双盲法≥40 s给予雷米芬太尼0.50 μg/kg(R1组)或0.75μg/kg(R2组)后,两组分别连续输注雷米芬太尼0.10μg/(kg·min);C组患者给予相同容量的0.9%氯化钠.记录麻醉诱导前(T0)、诱导后2 min(T1)、首次给予雷米芬太尼或0.9%氯化钠后1 min(T2)、气管插管前即刻(T3)及气管插管后30 s(T4)、2 min(T5)和4 min(T6)的MAP和心率,并描记心电图.结果 与C组比较,R2组T4～T6时QTc间期明显缩短(P＜0.05或＜0.01＝;R,组T4和C组T4～T6时QTc间期较T0明显延长(P＜0.05或＜0.01).C组气管插管期OTc间期＞440ms 11例(44%,11/25),R2组3例(12%,3/25),两组比较差异有统计学意义(P＜0.05).结论 芬太尼和普鲁泊福麻醉诱导气管插管期间患者的QTc间期是延长的;插管前1 min静脉注射雷米芬太尼0.75μg/kg,继以0.10 μg/(kg·min)输注可有效抑制气管插管诱发QTc间期延长和血流动力学反应.

Abstract：

Objective To evaluate the effect of remifentanil on mean arterial pressure (MAP), heart rate (HR) and QTc interval during tracheal intubation of general anesthesia patients. Methods Seventy-five ASA Ⅰ -Ⅱ grade patients were selected and allocated to receive either saline (group C), remifentanil 0.50 μg/kg (group R1) or remifentanil 0.75 μg/kg(group R2) by random digits table with 25 cases in each, they were administrated as a bolus intravenous, followed by a continuous infusion at 0.10 μg/ (kg·min), 1 min before laryngoscopy. All patients received fentanyl 3 μg/kg,propofol 1.0 - 1.5 mg/kg and vecuronium 0.1 mg/kg. The ECG.MAP and HR were recorded prior to induction of anesthesia (T0), 2 min following the start of drug intravenous of fentanyl and propofol with vecuronium (T1), 1 min following remifentanil or saline (T2), before laryngoscopy(T3), 30 s (T4), 2 min (T5) and 4 min (T6) after intubation. Results The QTc interval was significantly prolonged immediately following intubation in group C and group R1, but it remained stable in group R2, compared with the QTc interval just before laryngoscopy. In group R2, QTc interval was significantly shorter at T4-T6 compared to group C(P＜ 0.05 or ＜ 0.01). QTc interval significantly increased from baseline at T4 in group R1 and T4-T6 in group C (P＜ 0.05 or ＜ 0.01). The number of patients with QTc interval ＞ 440 ms were significantly greater immediately following tracheal intubation in group C than that in group R2 [44% (11/25) vs. 12% (3/25)] (P ＜ 0.05). Conclusions QTc interval increases following tracheal intubation during induction of anesthesia using fentanyl and propofol. Intravenous of remifentanil attenuates the QTc interval prolongation associated with tracheal intubation. In addition, remifentanil decreases the hemodynamic responses to tracheal intubation.     

双管喉罩在脊柱后路手术中的安全性和有效性

目的 探讨双管喉罩在脊柱后路手术中应用的临床效果及安全性.方法 40例ASA分级Ⅰ～Ⅱ级择期行胸腰椎骨折手术患者按照机械抽样法随机分为双管喉罩组和气管插管组,每组20例.两组患者常规麻醉诱导后,分别置入双管喉罩或气管插管.观察记录操作次数、时间;记录诱导前(T0),置入即刻(T1),置入后1 min(T2)、3 min(T3)、5 min(T4)、10 min(T5)及拔除即刻(T6)的收缩压、舒张压、心率;记录置入、拔除及维持通气过程中的并发症.结果 两组置人双管喉罩和气管插管均一次成功,所需时间比较差异无统计学意义(P＞0.05).气管插管组T1、T2、T3、T6时收缩压、舒张压、心率显著高于T0(P＜0.05),且也显著高于双管喉罩组(P＜0.05).气管插管组置人、拔除、维持通气过程中发生并发症者(5、25、36例次)明显多于双管喉罩组(0、1、6例次)(P＜0.05).结论 双管喉罩用于脊柱后路手术是安全和有效的.

Abstract：

Objective To explore the effect iveness and safety of ProSeal laryngeal mask(PLMA)used in posterior spinal surgery. Methods Forty ASA Ⅰ - Ⅱ patients of thoracic-lumbar fracture were randomly divided into PLMA group and tracheal intubation (TI) group by systematic sampling with 20 cases each. PLMA or TI was inserted after intravenous anesthesia induction. The number of intubation, intubation time and time to surgery were recorded, systolic blood pressure (SBP), diastolic blood pressure (DBP), and heart rate (HR) were recorded induction (To), during intubation (T1), at 1 min (T2),3 min(T3), 5 min (T4), 10 min after intubation (T5), during extubation (T6). The intubation, extubation, and the maintain ventilation process of the respiratory and respiratory damage were recorded. Results All patients in PLMA group and TI group achieved satisfactory lung ventilation at the first attempt. There were no significant difference in the number of intubation, intubation time and time to surgery between two groups (P ＞ 0.05 ).SBP,DBP,HR at T1,T2,T3,T6 in TI group were significandy higher than To and those in PLMA group (P＜0.05). The intubation, extubation, and the maintain ventilation process of the respiratory and respiratory damage in TI group (5,25,36 cases) were more than those in PLMA group (0,1,6 cases)(P ＜0.05).Conclusion PLMA for posterior spinal surgery is safe and effective.     

磷酸肌酸钠用于心肌缺血患者围手术期的疗效评价

目的 观察磷酸肌酸钠对心肌缺血患者围手术期血流动力学、人心肌脂肪酸结合蛋白(hFABP)及心肌肌钙蛋白I(cTnI)的影响.方法 选择术前心电图检查提示有广泛心肌缺血患者40例,ASA分级Ⅱ～Ⅲ级,采用随机数字表法分为磷酸肌酸钠组和对照组,每组20例.两组均常规术前准备,磷酸肌酸钠组手术前3 d加用磷酸肌酸钠2g/d,至手术当日麻醉诱导前.分别记录手术前3 d(T0)、麻醉诱导前即刻(T1)、气管插管后即刻(T2)、气管拔管后即刻(T3)血流动力学参数:平均动脉压(MAP)、心率、心排出量(CO)、每搏指数(SI)、肺血管阻力(PVR);各时间点分别抽静脉血测定hFABP及cTnI的含量.结果 两组心率在T0～T3比较差异无统计学意义(P＞0.05),磷酸肌酸钠组T1～T3 MAP、C0、SI明显高于对照组(P＜0.05),PVR、hFABP及cTnI明显低于对照组(P＜0.05).磷酸肌酸钠组术中心律失常发生率[20%(4/20)]明显低于对照组[45%(9/20)](P＜0.05).结论 心肌缺血患者围手术期应用磷酸肌酸钠对心肌有良好的保护作用.

Abstract：

Objective To observe the influence of sodium phosphocreatine on the hemodynamics,human heart fatty acid binding protein (hFABP),cardiac troponin Ⅰ (cTnI) during perioperative period.Methods Forty patients (ASA grade Ⅱ to Ⅲ ) with extensive myocardial ischemia diagnosed by preoperative electrocardiogram were divided into two groups:sodium phosphocreatine group (group A) and control group (group B) with 20 cases each by random digits table. Both groups underwent routine preoperative preparation and group A were given sodium phosphocreatine 2 g/d till anesthesia induction immediately in the operation day. Hemodynamic parameters including mean artery pressure (MAP),heart rate (HR),cardiac output (CO), stroke index (SI) and pulmonary vascular resistance (PVR) were recorded respectively at 3 d before treatment (T0), anesthesia induction immediately before ( T1 ), tracheal intubation immediately after (T2),tracheal extubation immediately after (T3). And blood hFABP and cTnl levels were detected. Results Compared with group B, there was no significant difference in HR of group A at To to T3 (P ＞ 0.05 ). MAP,CO, SI at T1 to T3 of group A were significantly higher than those of group B(P＜ 0.05 ) ;whereas PVR,blood hFABP and cTnI levels were lower than those of group B (P ＜ 0.05 ). The incidence of arrhythmogenesis of group A [20%(4/20)] was lower than that of group B [45%(9/20)](P＜0.05). Conclusion Sodium phosphocreatine has good protective effect on the myocardium in the patients with myocardial ischemia during perioperative period.     

纤维支气管镜引导经鼻插管与喉镜明视插管对血流动力学和血氧饱和度的影响

目的 探讨纤维支气管镜(FOB)引导下经鼻气管插管与喉镜明视气管插管对血流动力学和动脉血氧饱和度(SaO2)的影响.方法 将61例行气管插管机械通气的患者按随机数字表法分为观察组(31例)和对照组(30例),分别采用FOB引导下经鼻气管插管和喉镜明视气管插管,测定并记录两组患者在插管前1 min、插管即刻、插管后5 min的收缩压(SBP)、舒张压(DBP)、心率(HR)以及SaO2.结果 两组患者气管插管操作均获得成功,其中观察组用时(35.2±12.5)s,对照组用时(38.7±13.6)s,两组气管插管时间比较差异无统计学意义(P＞0.05).两组患者在插管即刻的SBP、DBP和HR均较插管前1 min显著升高,SaO2则显著下降,而且观察组上述指标的变化幅度均显著小于对照组(P＜0.05).结论 FOB引导下经鼻气管插管对患者血流动力学及SaO2的影响较小,是一种比较安全的气管插管方法,值得临床推广应用.

Abstract：

Objective To investigate the effect of nasal intubation guided by fiberoptic bronchoscope (FOB) and intubation guided by laryngoscope on hemodynamics and arterial oxygen saturation (SaO2).Methods Sixty-one patients received tracheal intubation for mechanical ventilation were divided into observation group (31 cases) and control group (30 cases) by random digits table who received FOB guided nasotracheal intubation and laryngoscope intubation respectively, the systolic blood pressure (SBP),diastolic blood pressure (DBP), heart rate (HR) and SaO2 of all patients in two groups was measured and recorded 1 min before intubation, the intubation moment and 5 min after intubation. Results Patients in two groups were successfully intubated. The average time in observation group was (35.2 ± 12.5) s and in control group was (38.7 ± 13.6) s, and there was no significant difference between two groups (P ＞ 0.05);SBP, DBP and HR of two groups at the intubation moment increased significantly than that at 1 min before intubation, while SaO2 decreased significantly, and the rangeability of above indexes in observation group were significantly lower than those in control group, there were significant differences between two groups (P ＜ 0.05). Conclusion FOB guided nasotracheal intubation has little effect on hemodynamics and blood SaO2, it is a safe method of endotracheal intubation and worthy of clinical application.     

不同麻醉方式下经皮肾穿刺碎石术的临床观察

目的 比较全身麻醉与椎管内麻醉下经皮肾穿刺碎石术(PCNL)患者循环、呼吸、体温的变化以及麻醉恢复期相关并发症的发生情况,以评价麻醉效果与安全性.方法 ASA分级Ⅰ～Ⅱ级择期行PCNL患者40例,按随机数字表法分为气管内插管全身麻醉组(Ⅰ组)和椎管内麻醉组(Ⅱ组),每组20例.记录两组患者的体温、心率、平均动脉压(MAP)、脉搏血氧饱和度(SpO2)的变化及恢复期不良反应发生情况.结果 Ⅰ组麻醉过程平稳,各时间点MAP、心率无明显变化;Ⅱ组麻醉效果确切,但麻醉后15 min的MAP及截石位后、俯卧位后的心率和MAP均较麻醉前和Ⅰ组有明显变化(P＜0.05).两组患者麻醉后30、60、90、120min的体温均较麻醉即刻有不同程度的下降(P＜0.05),且Ⅰ组患者麻醉后30、60min体温[(35.8±0.6)、(34.8±0.5)℃]明显低于Ⅱ组[(36.2±0.6)、(35.6±0.5)℃](P＜0.05).两组患者麻醉恢复期寒战、恶心、咽痛、背部不适均有发生,其中以发生寒战者最多.结论 两种麻醉方式均适用于PCNL;椎管内麻醉下术中需严密观察患者的各项生命指标;而对于肥胖、体质较弱、呼吸循环代偿功能较差的患者宜选用气管内插管全身麻醉.

Abstract：

Objective To compare the influences of general anesthesia and intra spinal anesthesia on circulation, respiration, body temperature and anesthesia-related complications in patients undergoing percutaneous nephrolithotomy (PCNL), and assess the effectiveness and safety of both anesthesia. Methods Forty ASA Ⅰ - Ⅱ patients elective for PCNL surgery were divided into two groups by random digits table with 20 cases each:group Ⅰ (endotracheal general anesthesia) and group Ⅱ (intra spinal anesthesia). The temperature, heart rate (HR), mean arterial pressure (MAP), pulse oxygen saturation (SpO2) values and postoperative shivering, nausea, vomiting, back discomfort and the incidence of sore throat were observed and recorded. Results The anesthesia was stable, there were no changes in MAP, HR at different time in group Ⅰ . The anesthesia in group Ⅱ was effective, MAP at 15 min after anesthesia,and HR,MAP after lithotomy position and prone position were obviously changed in group Ⅱ compared with those before anesthesia and group Ⅰ (P ＜ 0.05 ). The temperature at 30,60,90, 120 min after anesthesia decreased compared with that before anesthesia in two groups (P ＜ 0.05 ), and the temperature at 30,60 min after anesthesia in group Ⅰ [(35.8 ±0.6), (34.8 ± 0.5)℃] was lower than that in group Ⅱ [(36.2 ± 0.6),(35.6 ± 0.5)℃](P＜ 0.05).During recovery,complications such as shivering, nausea,sore throat, back discomfort occurred to some extent, of which the incidence of shivering was the highest. Conclusion Both of two anesthesia are applicable to PCNL. When intra spinal anesthesia is used,the life indicators of patients need to be observed and general anesthesia is preferable for the obesity,less physical and the old with poorly compensatory function.     

Effects of oxidative stress and NF-κB levels in peripheral blood mononuclear cells on development of silicosis

Objective To investigate the change of indicators of oxidative stress in serum and NF-κB in peripheral blood mononuclear cells of patients with silicosis, and explore the mechanism of the development of silicosis. Methods The subjects were divided into (1) 200 workers exposed to SiO2 for at least 1 years in a foundry served as the dust-exposure group; (2) 130 cases with silicosis (Ⅰ phase silicosis 64 cases, Ⅱ phase 46 cases Ⅲ phase 20 cases) served as the silicosis goup; (3) 32 cases with 0+ phase silicosis in the foundry served as the observed group,(4)100 subjects from a hotel served as the control group. The serum including superoxide dismutase (SOD), nitric oxide (NO), serum glutathione peroxidase (GSH-Px), total antioxidant capacity (T-AOC), nitric oxide synthase (NOS), lipid malondialdehyde (MDA) and NF-κB protein levels in peripheral blood mononuclear cells were determined, respectively. Results Compared with the control group,NO levels in dust-exposed group and silicosis group significantly increased, and SOD decreased significantly (P＜0.05 or P＜0.01). Compared with the control group and dust-exposed group, T-AOC, NOS, MDA levels in silicosis group significantly increased (P＜0.05 or P＜0.01). GSH-Px in dust-exposed group and silicosis group were (231.164±36.484) and (270.469±39.228)U/md, respectively which were significantly than that [(223.360±46.838) U/ml] in control group (P＜0.05 or P＜0.01), and there was significant difference of GSHPx between the silicosis group and the dust-exposed group significantly (P＜0.01). GSH-Px level [(290.750±39.129) U/ml] in Ⅲ phase silicosis group were significantly higher than those [(256.906±21.41) and (259.594±34.79) U/ml] in observation group and Ⅰ phase silicosis group (P＜0.05). NF-κB levels [(72.06±9.12) and (85.25±11.64) ng/L] in dust-exposed group and silicosis group were significantly higher than that [(59.71±9.27) ng/L] in control group (P＜0.01), and there was significant difference of between the silicosis group and the dust-exposed group (P＜0.01). There was a positive correlation between serum GSH-Px level and the silicosis stages (r=0.507,P＜0.0l). Also there was a positive correlation between NF-κB level and silicosis stages, age, GSH-Px or NO levels (r=0.376, 0.243, 0.233, 0.221, P＜0.01). Conclusion The imbalance of oxidative and anti-oxidation system and the activation of NF-κB are related with the occurrence and development of silicosis. The monitoring of oxidative stress indicators and NF-κB is beneficial to the prediction and prognosis assessment of silicosis.     

直视下小鼠气管插管方法的比较

Objective To explore a safe and efficient method for endotracheal intubation in mice.Methods 60 BALB/c mice were random divided into 2 groups, direct intubation under direct vision group, ( n = 30) and direct intubation under light by transillumination group ( n = 30).After successful tracheal intubation at the first judgment, mouse received a tracheal instillation of 3 mg/kg lipopolysaccharide.Bronchoalveolar lavage (BAL) was then performed three times with 0.8 ml sterile saline.Exudate cells were centrifuged and stained with Wright's fluid.Whether the intubation indeed succeeded was judged by the amount of neutrophil infiltrated into the lungs.The mortality after intubation, the time consumed for each successful tracheal intubation and the times of attempting for intubation in two groups were assessed to approve the efficiency of two techniques.Results Eight vs.two mice died within 24 hours in two groups respectively.The time consumed for each successful tracheal intubation and success rate for the first time for two groups were (92.6 ±23.4)s vs (64.0±20.1)s and 53.3% vs 86.7% respectively, which the consumed time was significantly different, while the final success rate almost the same for the two groups.Conclusion Both direct intubation under direct vision and intubation under light by transillumination can successfully intubate the tube into the trachea.But direct intubation under direct vision by transillumination is more efficient and safe in endotracheal intubation in mice.     

直视下小鼠气管插管方法的比较

Objective To explore a safe and efficient method for endotracheal intubation in mice.Methods 60 BALB/c mice were random divided into 2 groups, direct intubation under direct vision group, ( n = 30) and direct intubation under light by transillumination group ( n = 30).After successful tracheal intubation at the first judgment, mouse received a tracheal instillation of 3 mg/kg lipopolysaccharide.Bronchoalveolar lavage (BAL) was then performed three times with 0.8 ml sterile saline.Exudate cells were centrifuged and stained with Wright's fluid.Whether the intubation indeed succeeded was judged by the amount of neutrophil infiltrated into the lungs.The mortality after intubation, the time consumed for each successful tracheal intubation and the times of attempting for intubation in two groups were assessed to approve the efficiency of two techniques.Results Eight vs.two mice died within 24 hours in two groups respectively.The time consumed for each successful tracheal intubation and success rate for the first time for two groups were (92.6 ±23.4)s vs (64.0±20.1)s and 53.3% vs 86.7% respectively, which the consumed time was significantly different, while the final success rate almost the same for the two groups.Conclusion Both direct intubation under direct vision and intubation under light by transillumination can successfully intubate the tube into the trachea.But direct intubation under direct vision by transillumination is more efficient and safe in endotracheal intubation in mice.     

麻醉深度指数在靶控输注丙泊酚-雷米芬太尼麻醉诱导中的监测及评价

目的　评价麻醉深度指数(CSI)在靶控输注丙泊酚-雷米芬太尼麻醉诱导过程中预测患者麻醉深度的精确程度.方法全身麻醉下行择期手术患者44例,ASA分级Ⅰ～Ⅱ级,以效应室靶浓度4　ng/mnl靶控输注雷米芬太尼,输注10　min时开始靶控输注丙泊酚,丙泊酚初始效应室靶浓度均为1.5　μg/ml,每4min增加0.5　μg/ml,改良警觉/镇静评分为1分时给予强直刺激,直至改良警觉/镇静评分为0分后1min停止试验.试验中监测患者CSI、平均动脉压(MAP)、心率、每20　s行改良警觉/镇静评分、靶控输注系统预测效应部位浓度.结果CSI随改良警觉/镇静评分下降而下降,改良警觉/镇静评分5分时CSI为91±5,4分时为77±7,3分时为70±7,2分时为62±6,1分时为49±12,0分时为36±10,两个相邻改良警觉/镇静评分比较差异均有统计学意义(P＜0.05);MAP及心率在两个相邻改良警觉/镇静评分比较差异无统计学意义(P＞　0.05).CSI与改良警觉/镇静评分的Spearman等级相关系数、预测概率值均大于CSI与MAP,差异有统计学意义(P＜0.01或＜0.05).CSI与丙泊酚靶控输注预测效应部位浓度存在线性回归关系(决定系数为0.812,P＜0.01).结论在成年患者靶控输注丙泊酚-雷米芬太尼麻醉诱导状态下,CSI能够准确地区分清醒和麻醉后的不同意识水平,可靠地预测麻醉深度.     

两种麻醉方法用于支撑喉镜老年患者声带息肉手术的效果比较

目的：比较七氟醚和丙泊酚用于支撑喉镜老年患者声带息肉手术的麻醉效果。方法：择期拟行声带息肉手术患者90例,随机分为七氟醚组（Sev组）和丙泊酚组（Pro组）,每组45例。Sev组给予4%七氟醚吸入联合瑞芬太尼、琥珀胆碱静脉诱导气管插管,术中七氟醚吸入联合瑞芬太尼、琥珀胆碱静脉维持麻醉。Pro组给予丙泊酚1mg/kg联合瑞芬太尼、琥珀胆碱静脉诱导气管插管,术中丙泊酚联合瑞芬太尼、琥珀胆碱静脉维持麻醉。记录并比较两组患者麻醉前,插管前、插管后平均动脉压（MAP）、心率（HR）的变化,比较两组术后苏醒时间、拔管时间的差异。结果：麻醉前、插管后两组血流动力学参数比较,差异无统计学意义,插管前Pro组MAP、HR显著低于Sev组（P〈0.05）;Sev组术后苏醒时间及拔管时间均显著低于Pro组（P〈0.05）。结论：七氟醚用于支撑喉镜老年声带息肉手术的麻醉时,对血流动力学影响较轻,能显著缩短术后苏醒时间和拔管时间,是一种安全有效的麻醉方法。     

瑞芬太尼-异丙酚靶控输注静脉麻醉在妇科腹腔镜手术中的应用

目的评价瑞芬太尼-异丙酚靶控静脉麻醉在妇科腹腔镜手术中的疗效。方法选择2000—2006年择期妇科腹腔镜手术患者120例，ASAⅠ～Ⅱ级，年龄19～57岁，体重40～75kg。随机分为微量泵输注瑞芬太尼-异丙酚组（Ⅰ组，60例）和芬太尼异氟醚组（Ⅱ组，60例）。术中连接多功能监护仪，观察围术期两组血流动力学变化，入室至麻醉苏醒期间持续监测动脉收缩压（SBp）、舒张压（DBp）、心率（HR）、氧饱和度（SpO2）。结果两组中T1、T2和T3的SBp、DBp、HR值与基础值（T0）相比，均显著下降（P〈0．05）；气腹后10min（T2）Ⅱ组SBp、DBp、HR值均高于Ⅰ组，Ⅱ组气腹毕（T3）SBp、DBp高于Ⅰ组（P〈0．05），Ⅰ组术中各时段血压与诱导前相比低且平稳；Ⅰ组病人术后自主呼吸恢复时间、睁眼时间及拔管时间较Ⅱ组明显缩短（P〈0．05）。结论微量泵输注瑞芬太尼-异丙酚麻醉应用于妇科腹腔镜手术，诱导更加平稳，苏醒迅速，有效且安全。     

瑞芬太尼全麻诱导气管插管对血流动力学的影响

目的观察瑞芬太尼全麻诱导插管对血流动力学的影响,探讨瑞芬太尼减轻全麻气管插管引起应激反应的效果及安全性。方法选择期手术、ASAⅠ-Ⅱ级患者40例,随机分为观察组和对照组,每组20例。两组患者入室后静脉输注乳酸钠林格注射液(10ml/kg),观察组依次静注咪达唑仑0.04mg/kg、顺苯磺酸阿曲库铵0.15mg/kg、依托咪酯0.15mg/kg、瑞芬太尼2ug/kg、异丙酚1mg/kg,2min后行气管插管,对照组用生理盐水代替瑞芬太尼,余同观察组用药。记录麻醉诱导前,插管前即刻,插管后1min、3min、5min的HR、MAP及ECG变化。结果与诱导前比较,插管前观察组MAP呈显著性降低(P<0.01);插管后1min对照组MAP显著性增高(P<0.01),而观察组低于诱导前水平(P<0.05);插管后5min两组患者达诱导前水平(P<0.05),组间比较无统计学意义(P>0.05)。插管后1min对照组HR显著高于诱导前(P<0.01),其余各时点两组组内及组间比较无统计学意义(P>0.05)。对照组4例ECG观察到明确的ST-T改变。结论瑞芬太尼可明显减轻气管插管时的心血管反应,但对血容量不足的患者可能存在严重低血压的潜在风险。     

顺阿曲库铵用于气管插管最佳预注与插管剂量的探讨

目的 观察不同预注方法与插管剂量的顺阿曲库铵用于全麻诱导气管捕管的起效时间和安全性.方法 将80例ASA分级Ⅰ～Ⅱ级择期全麻腹部手术患者用随机数字表法分为四组,每组20例,Ⅰ、Ⅱ、Ⅲ组分别预注顺阿曲库铵0.010 mg/kg(20% ED95)、0.015 mg/kg(30% ED95)、0.010 mg/kg(20% ED95),Ⅳ组预注0.9%氯化钠.4 min后给予插管剂量顺阿曲库铵:Ⅰ组0.140 mg/kg、Ⅱ组0.135 mg/kg、Ⅲ组0.190 mg/kg、Ⅳ组0.200 mg/kg.肌松监测仪监测拇内收肌四个成串刺激(TOF)和TOF的第一个肌颤搐(T1),当T1=0时,进行气管插管,记录预注间隔T1、TOF值及起效时间,并评价插管条件.结果 Ⅰ、Ⅱ、Ⅲ、Ⅳ组起效时间分别为(151.30±10.90)、(138.90±8.37)、(145.45±17.12)、(148.75±18.70)s.Ⅱ组起效时间明显短于Ⅰ、Ⅲ、Ⅳ组(P＜0.01).在预注间隔内,四组T1和TOF均呈下降趋势,Ⅱ组出现TOF＜90%.结论 顺阿曲库铵预注剂量0.010 mg/kg后给予插管剂量0.140 mg/kg的起效时间与有或无预注下插管剂量0.200 mg/kg相似,且预注间隔内不影响TOF值,故为首选.预注不能加快4倍ED95顺阿曲库铵起效时间.30% ED95的预注剂量在4 min的预注间隔出现TOF＜90%,用于临床的安全性差.     

七氟烷复合咪达唑仑、瑞芬太尼、普鲁泊福用于术中无肌肉松弛药麻醉效果的观察

目的 评价吸入麻醉剂七氟烷复合咪达唑仑、瑞芬太尼、普鲁泊福在患者短小手术中无肌肉松弛药的麻醉效果.方法 选择全麻手术患者50例,ASA分级Ⅰ～Ⅱ级.麻醉诱导:静脉注射咪达唑仑0.03 mg/kg后面罩吸入七氟烷,待患者睫毛反射消失时,1 min内缓慢静脉注射瑞芬太尼2μg/kg,同时继续吸入七氟烷,30 s后气管插管行机械通气.麻醉维持:七氟烷持续吸入、普鲁泊福和瑞芬太尼持续泵注.于诱导前、睫毛反射消失时、气管插管前即刻和气管插管后即刻,记录平均动脉压(MAP)、心率、脉搏血氧饱和度(SpO_2)和脑电双频指数(BIS);记录从开始吸人七氟烷到睫毛反射消失时间;评估气管插管条件,术毕停药后记录呼之睁眼时间、自主呼吸恢复时间、拔管时间及清醒程度(采用拔管后5 min镇静评分判断).结果 50例患者均一次性完成气管插管,气管插管条件达优率为82%(41/50),从开始吸入七氟烷到睫毛反射消失时间为(73±12)s,气管插管后即刻MAP、心率和SpO_2与气管插管前即刻比较差异无统计学意义(P>0.05).气管插管前后维持BIS在45～55.术后苏醒迅速,苏醒质量优良.结论 七氟烷复合咪达唑仑、瑞芬太尼麻醉诱导平稳,气管插管条件优良,再复合普鲁泊福维持麻醉后患者苏醒迅速完全,短小手术中无肌肉松弛药麻醉是一种安全可行的麻醉方法.     

奥曲肽对兔肝缺血再灌注后肺损伤的影响

目的 探讨奥曲肽在兔肝缺血再灌注后对远处器官肺损伤的影响.方法 采用Pring＇s兔肝脏再灌注模型,将24只新西兰大白兔随机分为三组：Ⅰ组（假手术组）、Ⅱ组（肝脏缺血再灌注生理盐水组）、Ⅲ组（奥曲肽预适应组）.Ⅲ组于腹腔内注射20μg/kg奥曲肽和皮下注射30μg/kg奥曲肽,均用0.9%的生理盐水稀释至2 ml,其他组在同一时间点用同样途径注射等量生理盐水.观察三组动物肝门阻断前（T1）、阻断后30 min（T2）、再灌注后30 min（Ts）、60 min（T4）、120 min（T5）、240min（T6）平均动脉压和心率的变化,以及T1、T2、T3、T4、T5、T6各时间点肿瘤坏死因子α（TNF-α）和白介素-1β（IL-1β）的变化,再灌注后240rain时处死兔子,取肺组织在透射电镜下观察各组肺细胞超微结构的变化,采用TUNEL法检测其凋亡细胞.结果 MAP和HR在T2至T4时间点Ⅱ组、Ⅲ组明显低于Ⅰ组,而Ⅱ组显著低于Ⅲ组（P〈0.05）;Ⅱ组从T2开始、Ⅲ组从T3开始两组血浆TNF-α、IL-β显著高于Ⅰ组（P〈0.05）,且Ⅲ组从T2开始后各时点血浆TNF-α和IL-β明显低于Ⅱ组（P〈0.01）;透射电镜下Ⅲ组肺的亚细胞结构损伤显著轻于Ⅱ组,采用TUNEL法检测肺组织中的凋亡细胞数在5个高倍镜下Ⅱ组（55.82±4.19）、Ⅲ组（32.17±3.10）明显多于Ⅰ组（3.96±0.87）,而Ⅲ组显著少于Ⅱ组（P〈0.01）.结论 奥曲肽对于兔肝缺血再灌注后远处器官肺的损伤确有保护作用.